The Application Of Dexmedetomidine In Elderly Patients With Percutaneous Vertebroplasty

Objective To observation the effects of sedation analgesia and the safety ofdexmedetomidine in elderly patients with percutaneous vertebroplasty.Methods120patients(65~78y, ASA Ⅰ to Ⅲ)were collected for PVP operation underlocal anesthesia Select. The patients were divided randomly into four groups,30patientsfor each. Operation posture are prone position. Group A, Continuous infusion of0.9%saline; Group B, Given the0.03mgkg﹣1of midazolam, then0.05mgkg﹣1h﹣1intravenousmidazolam was maintained; Group C, Given the0.15μgkg﹣1of Sufentanil, Given the0.02mgkg﹣1of midazolam, then0.05mgkg﹣1h﹣1intravenous midazolam was maintaineduntil the end of operation; Group D, Given the0.7μgkg﹣1of dexmedetomidine over10min, then0.05mgkg﹣1h﹣1intravenous midazolam was maintained until the end ofoperation. For the first time after intravenous administration of local anesthesia for theoperation. The changes of MAP, HR, SPO2were monitored. The above parameters wererecorded at time before anasthesia(T0)、 local anesthesia(T1)、 the needle of thespine(T2)、the injection of bone cement(T3)、at the end of operation(T4). VAS scorewere monitored at T1、T2、T3to evaluated the pain sense lever. Ramsay sedation scalewere monitored at T0、T1、T2、T3、T4. The incidence and degree of advese effect asnausea and vomiting, hypertension, Heartbeat tachycardia, Heartbeat bradycardia,respiratory inhibition were recorded. The normal distribution data were analyzed byPaied–sample T test and ANOVA. Significance was established at P<0.05.Results There were on significant differences of MAP, HR, SPO2, Ramsay at T0among four groups(P>0.05). The value of MAP, HR were showed significant higher atT1, T2, T3than T0in group A(P<0.05), T4is fall；The value of MAP were showedsignificant higher at T1, T2, T3than T0in group B(P<0.05), T4back to T0level; Thevalue of MAP, HR were showed slight increase at T1, T2, T3than T0in groupC(P>0.05), T4is fall; The value of MAP, HR were showed dropped slightly. T1, T2, T3than T0in group D(P>0.05); The value of MAP, HR were in lower in group C and Dthan in group A and B at T1, T2, T3(P<0.05); There were on significant differences ofMAP, HR at T4(P>0.05), butis lower than group A(P<0.05); The value of MAP, HRwere on significant in group D(P>0.05）. The Ramsay scales among the four groups are comparable in T0(P>0.05). In timepoints of T1, T2, T3, T4the Ramsay scales in group B, group C and group D were higherthan time points of T0(P<0.05), In time points of T1, T2, T3, T4the Ramsay scales ingroup C and group D were higher than time points of T0(P<0.05), In time points of T1,T2, T3the Ramsay scales in group C and group D were higher than in group A and groupB(P<0.05); The Ramsay scales among group B, group C and group D are comparable inT4(P>0.05), but is higher than in group A(P<0.05); there were on significant differencesbetween group C and group D(P>0.05). At T1, T2, T3, T4compared to group A and B,The Ramsay scales in group C and D were lower(P<0.05), In group C and D there wereon significant difference(P>0.05).Respiratory depression was discovered in group B and C, group B(5patients), groupC(8patients), SPO2declined to below90%. By means of the increase of oxygen flow,care mandible treatment, patients return to normal. Symptoms of nausea and vomitingwas discovered in three patients in group C, given antiemetic symptomatic treatment. Theremaining no other adverse reactions.Conclusions Infusion of0.7μgkg﹣1dexmedetomidine over10min, then0.05mgkg﹣1h﹣1dexmedetomidine was maintained in elderly patients with percutaneous vertebroplasty,The effects of sedative and analgesic is satisfied. Stable hemodynamics, without adversereaction, safe and effective, with strong sense of comfort.